1730437732 NPI number — MEREDITH L. FOX PA-C

Table of content: MEREDITH L. FOX PA-C (NPI 1730437732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730437732 NPI number — MEREDITH L. FOX PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOX
Provider First Name:
MEREDITH
Provider Middle Name:
L.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEAVER
Provider Other First Name:
MEREDITH
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730437732
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 742616
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-2616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-219-8420
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4919 ATLANTA HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLOWERY BRANCH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30542-3328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-848-9160
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  6487 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 006487 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)